Understanding the Relationship Between Autism and Post-Traumatic Stress

By Nomi Kaim
August 2, 2019

Autism and Post-Traumatic Stress. My past wasn’t that bad, but I will never get over it.

Like many people on the autism spectrum, I seem to be incapable of letting go. I perseverate on my interests, which is enjoyable. I worry about my future, which is frightening. And I ruminate about my past . . . which is exhausting.

While I can ruminate about anything, I ruminate most about my bipolar disorder, a devastating condition that I developed as a teenager already living with the stresses of autism. I know mental illness is often triggered by stress. If I had responded differently somehow, reached out sooner, established different patterns of thinking, could I have avoided getting bipolar? I have lost years of my life asking this unanswerable question.

What is it about autism that makes the mind so sticky?

The Autism–PTSD Connection

Autism is a genetic neurodevelopmental disorder that is not caused by childhood trauma or abuse. Again: child abuse is not the cause of autism. However, children who are severely abused—most disturbingly the 170,000 warehoused in Romanian orphanages in the 1960s through ’80s—often develop behaviors, such as social withdrawal and repetitive movements, that resemble autism.

Repetitive behaviors are central to autism. Repeatedly re-experiencing the past (despite efforts not to) is central to PTSD. Perhaps it is not surprising that the two should overlap.

Research is also shedding light on the alarming prevalence of mental health problems in those with autism, including depression, anxiety, sleep and eating disorders, and suicidal thinking, all of which I have experienced. These conditions are commonly associated with trauma in some form.

In fact, one definition of trauma is an experience that overwhelms the nervous system and cannot be processed effectively. For people with autism, even everyday occurrences like noises, bright lights, and changes in routine can feel overwhelming because of hardwired processing difficulties. We respond by avoiding the distressing stimuli—avoidance being another core feature of PTSD.

All of this hints at a complex and poorly understood relationship between autism and PTSD. While autism is never caused by trauma, there may be something about living with autism that is inherently traumatic. This certainly fits with my experience.

Ways of Thinking

Why do bad things happen to good people? Why did we turn out the way we did, instead of better? Why are people so cruel? What does it all mean, anyway?

Not a day passes that I don’t contemplate such questions. I struggle against a potent drive to rehash past occurrences, big and small. It could be the onset of my bipolar disorder or a perceived social slight, a friend’s serious illness or that dumb thing I said last week. Small events provoke big questions, the kind that can’t be answered. Big events leave permanent scars. With every successive question, I relive the pain of the past. My inner world is an endless cycle of rumination and obsession that can be intercepted only temporarily and with great effort.

Unsolvable Problems

Autistic people are rule-abiding and seek out justice in our lives and in the world. Life frequently fails to mete out justice. This inconsistency has me in a perpetual chokehold, looking for reasons where there are none. Combine this with mind-blindness (the inability to take others’ perspectives) and strong atheism, and I am confused why anything happens the way it does.

Rumination is thought to represent a misguided attempt to solve a problem. When I have a problem to solve, I laser in on it with classic autistic vigor. I compile data, organize it, analyze it, reorganize it, begin again. Other responsibilities, relationships, day-to-day tasks—all can fade until I emerge, victorious, solution in hand. Or until I die trying. For, in the end, who can solve the problem of life’s random vicissitudes?

At its root, perhaps the hardest question to answer is why I am who I am, leading the life that I lead, rather than an easier-going person leading an easier life. The irony is that my life would be easier if I could let go of these questions and contact the richness of the moment.

Coping Alone

Connection is a powerful buffer against stress. In humans and other mammals, social interaction releases feel-good hormones that combat stress hormones. Social touch—such as a hug or a light touch on the arm—is especially powerful, at least for those without autism. Conversely, isolation and estrangement from family and community are major risk factors for the development of PTSD following trauma.

One of the most painful aspects of life with autism is the isolation. Friendships falter; relationships fail; we lose the support of classmates and co-workers if we can’t finish school or hold down a job. Enter the stereotype of the autistic recluse glued to the internet. Many of us live our whole lives with little to no intimate social contact or social touch, resulting in part from sensory integration problems. Beyond this profound isolation, there may be ostracization, bullying, or abuse—all traumatic, especially when experienced in a social vacuum.

I am acutely aware of the effect social interaction has on my own mental state. As a member of the Asperger / Autism Network in Watertown, MA, I feel much more connected now than I did in my younger years. When I engage warmly with that community, the onslaught of mental chatter, rumination, and worry switches off. Time spent socializing is time lived in the present.

So, What’s the Answer?

Awareness of the problem helps, as does socializing. Mindfulness. Acceptance. Patience. Self-compassion.

I don’t have any other answers, though I would be curious to hear some. I tend to circle back to step one: awareness. Maybe I will be stuck here for the rest of my life, watching myself as I repeatedly fail to let go, carrying my stress like a badge of my autism. I think I can live with that.